Bath salts toxicity: Difference between revisions
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== Background == | ==Background== | ||
[[File:RadoxBathSalts.jpg|thumb|Bath salts]] | |||
*Found in herbal products sold under guise of "not for human consumption" | *Found in herbal products sold under guise of "not for human consumption" | ||
**May be found under brand name Aura, Ivory wave, Vanilla sky | **May be found under brand name Aura, Ivory wave, Vanilla sky | ||
*Active ingredients vary; often contain methylenedioxyprovalerone (MDPV) or mephedrone | *Active ingredients vary; often contain methylenedioxyprovalerone (MDPV) or mephedrone | ||
*Similar effects to MDMA, cocaine, methamphetamines | *Similar effects to [[Ecstasy (MDMA)]], [[cocaine]], [[methamphetamines]] | ||
== Clinical | ==Clinical Features== | ||
Sympathomimetic | *[[Sympathomimetic toxicity|Sympathomimetic toxidrome]] | ||
**Tachycardia | **Tachycardia | ||
**Hypertension | **Hypertension | ||
| Line 14: | Line 13: | ||
**Paranoia | **Paranoia | ||
**Hyperthermia | **Hyperthermia | ||
* | *[[Hallucinations]] | ||
*Psychomotor agitation | |||
== Diagnosis == | ==Differential Diagnosis== | ||
{{Sympathomimetic types}} | |||
{{Drugs of abuse types}} | |||
== Work-Up == | ==Evaluation== | ||
===Work-Up=== | |||
*Fingerstick glucose | *Fingerstick glucose | ||
*Complete metabolic panel | *Complete metabolic panel | ||
*Coags | *Coags | ||
* | *CK | ||
* | *Urine tox screen not helpful, usually negative | ||
== | ===Diagnosis=== | ||
* | *Diagnosis is based on history and physical exam | ||
== | ==Management== | ||
*Benzodiazepines | *[[Benzodiazepines]] for agitation | ||
*Rapid cooling for hyperthermia | *Rapid cooling for hyperthermia | ||
*Paralyze if hyperthermia uncontrolled (avoid [[Succinylcholine]] due to hyperkalemia) | |||
*IV hydration | *IV hydration | ||
*Monitor urine output | *Monitor urine output | ||
== Disposition == | ===Contra-indicated=== | ||
*Discharge if AMS and sympathomimetic symptoms resolve | *Do not use butyrophenones (e.g. [[Haldol]]) or second gen antipsychotic (e.g. [[Geodon]]) as first line agents | ||
* | **They interfere with heat dissipation, lower seizure threshold, may prolong QTc | ||
==Disposition== | |||
===Admission=== | |||
*Admit for lab abnormalities or persistent [[Altered Mental Status (AMS)|AMS]] | |||
===Discharge=== | |||
*Discharge after observation period if [[Altered Mental Status (AMS)|AMS]] and [[Sympathomimetic toxicity|sympathomimetic]] symptoms resolve with out end-organ damage | |||
*MDPV has an estimated 6-8 hour duration of action, but may vary. Consider consult with poison control prior to discharge. | |||
==Complications== | |||
*[[Rhabdomyolysis]] | |||
*[[Cardiomyopathy]] | |||
*[[Valvular heart disease]] | |||
*Cardiac arrhythmias | |||
*[[Pulmonary hypertension]] | |||
*[[Aortic dissection]] | |||
*Acute tubular necrosis | |||
==See Also== | |||
*[[Sympathomimetic toxicity]] | |||
*[[Altered Mental Status (AMS)]] | |||
==External Links== | |||
*[http://www.emdocs.net/bath-salts/ emDocs - Bath Salts] | |||
== | ==References== | ||
<references/> | |||
[[Category: | [[Category:Toxicology]] | ||
Latest revision as of 23:29, 21 April 2022
Background
- Found in herbal products sold under guise of "not for human consumption"
- May be found under brand name Aura, Ivory wave, Vanilla sky
- Active ingredients vary; often contain methylenedioxyprovalerone (MDPV) or mephedrone
- Similar effects to Ecstasy (MDMA), cocaine, methamphetamines
Clinical Features
- Sympathomimetic toxidrome
- Tachycardia
- Hypertension
- Agitation
- Paranoia
- Hyperthermia
- Hallucinations
- Psychomotor agitation
Differential Diagnosis
Sympathomimetics
- Cocaine
- Amphetamines
- Synthetic cathinones (khat)
- Ketamine
- Ecstasy (MDMA)
- Synthetic cannabinoids
- Bath salts
Drugs of abuse
- 25C-NBOMe
- Alcohol
- Amphetamines
- Bath salts
- Cocaine
- Difluoroethane
- Ecstasy
- Gamma hydroxybutyrate (GHB)
- Heroin
- Inhalant abuse
- Hydrocarbon toxicity
- Difluoroethane (electronics duster)
- Marijuana
- Kratom
- Phencyclidine (PCP)
- Psilocybin ("magic mushrooms")
- Synthetic cannabinoids
- Chloral hydrate
- Body packing
Evaluation
Work-Up
- Fingerstick glucose
- Complete metabolic panel
- Coags
- CK
- Urine tox screen not helpful, usually negative
Diagnosis
- Diagnosis is based on history and physical exam
Management
- Benzodiazepines for agitation
- Rapid cooling for hyperthermia
- Paralyze if hyperthermia uncontrolled (avoid Succinylcholine due to hyperkalemia)
- IV hydration
- Monitor urine output
Contra-indicated
- Do not use butyrophenones (e.g. Haldol) or second gen antipsychotic (e.g. Geodon) as first line agents
- They interfere with heat dissipation, lower seizure threshold, may prolong QTc
Disposition
Admission
- Admit for lab abnormalities or persistent AMS
Discharge
- Discharge after observation period if AMS and sympathomimetic symptoms resolve with out end-organ damage
- MDPV has an estimated 6-8 hour duration of action, but may vary. Consider consult with poison control prior to discharge.
Complications
- Rhabdomyolysis
- Cardiomyopathy
- Valvular heart disease
- Cardiac arrhythmias
- Pulmonary hypertension
- Aortic dissection
- Acute tubular necrosis